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FOR OFFICE USE: APPLICATION FORxSANITATION PERMIT --- ------------------------------- Permit No. .-7_--'-7C9-a- (Complete in Triplicate) -------_---------------------------------____--_----" This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---S-7 --2-4- M-0-A-4-DA------------ -----------------------CENSUS TRACT - ---------_____ Owner's Name ------7;91 "- ws--------------------------------------------- -------Phone 417V.77t5:5-7---- Address ------,QAO-V -- -4W"=-------------- City ------------------- -- ---------- Contractor's Name -------.a•--_-°S----------------------------------------License Phone "� � Installation will serve: Residence*Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other -------------- ---------------------------- Number of living units:-----/----- Number of bedrooms __3-----Garbage Grinder 1V0__ Lot Size 14VX__34V------------------ Water Supply: Public System and name ------------------------------------------------------------------------------------------------ Private, ' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ Hardpan ❑ Adobe-kx Fill Material ------------ If yes,type ___________________________ (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT [ ] SEPTIC TANK, Size-- �C` -------------------- Liquid Depth - -- ,� -.______________ Capacity./OZ,l'p ype _ - --___ _ __ �Matericil�i4�o. Compartments -.9_-----_-____.- Distance to nearest: Weli ___.,— __________________Foundation __ ------------ Prop. Line ___. ------------- lr LEACHING LINE JV No. of Lines _-- ------------ Length of each line.------SIC f.------ Total Length ______________ 'D' Box Type Filter Material / _Depth Filter Material ___� ________ ____ 1 Distance toIynearest: Wel! ------ Foundation -_/0-"*".._._____ Property Line �07--------------- SEEPAGE PIT �[, ' Depth Q.��-____�-- Diameter J3--___ Number ----._�._" Rock Filled Yes y�' No i❑ Water Table Depth ' c Rock Size -/4f� 4+R -- '� -------------- Distance to'nearest: Well -_f��_______________________Foundation A�-_________ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------__----------------------------------- Date .---------.-____________--_-------) SepticTank (Specify Requirements) ------------------------------- --------------------------------- ------------------------------ ---------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- i -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------- 1 i I(Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: E "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." i Signed ----------- = ------------------------- Owner By ----------------------------- - ----------------------- Title han (If other towner) O DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE -----1>-----------"71? BUILDING PERMIT ISSUED -------- -------------------- DATE --------- --- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------------------- j ------------------- ---- ------- ------------------------- - �rj '1----------------- -------------------------- f- � - ------------ - ---------- ------------------- ---------- ------- - Final Inspection by: ------ fJ� f Date - C - --- ------------------ -------------------- - - -- ------ --- --- ZZ ---- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M